Clinical Case of Carotid and Coronary Artery Stenting by Distal Radial Access in a Patient with Arteria Lusoria

Abstract

Introduction. The performance of interventional procedures on carotid and sometimes coronary arteries through radial access remains to be a challenging task. The presence of a. lusoria (a. l.) is an example of the complex anatomy of the aortic arch and its branches, which is considered to be a contraindication for interventions on the coronary and carotid arteries through radial access. In this study, an analysis of the intervention strategy for combined atherosclerotic lesions of the carotid and coronary arteries was carried out using a clinical case of a. l. Materials and methods. Patient K., 56 years old, with multifocal atherosclerosis. Control angiography revealed an abnormal aortic arch with abnormal branches. The atherosclerotic lesions included a chronic occlusion of the right coronary artery (RCA) in the proximal segment with a significant stenosis of the right internal carotid artery. Results and discussion . Given the significant difficulties in catheterising the right common carotid artery through a.l., it was decided to catheterise the left radial artery distally. To achieve reliable support of the guiding catheter, the Claret technique was used. To that end, a JR 7.5F (ASAHI) guiding catheter was remodeled into a Simmons catheter. To facilitate the selective catheterisation of the right common carotid artery, a Pigtail 5F diagnostic catheter was used as an extension (mother-child technique). The presented strategy enabled a successful catheterisation of the right common carotid artery, eventually allowing passing all the necessary instruments through the guiding catheter into the internal carotid artery to perform the intervention. The second stage was the recanalisation of a chronic occlusion of the right coronary artery. For RCA catheterisation, the left radial artery was chosen. A JFR 6F Adroit (Cordis) guiding catheter proved to be the most convenient. With its proper support, the RKA was re-canalised using a Gaia Third coronary guide (ASAHI). In order to determine the position of the guide in the RCA distal part, a contrasting was performed from the LCA system. After the RCA re-canalisation, stents with an antiproliferative coating were implanted with a good angiographic result. Conclusion. The described clinical case and technical solutions allow endovascular care through radial access to be provided to patients with abnormalities of the aortic arch.